Trying Rexulti as a New Medication: Part I

I’ve been in the midst of a manic episode for two months now. My most major symptoms have been irritability and agitation. I have problems focusing, partly because I can’t sit still and partly because my thoughts race like they’re trying to win the Triple Crown. This episode has led my psychiatrist to make some major changes to my medication regimen. Making these changes is not fun. It can come with a lot of negative outcomes even before the possibility of a positive outcome. One change is that I have now been prescribed Rexulti. It’s a fairly new drug and not yet approved for treating bipolar disorder, so I am cataloging and sharing my case with those who are also receiving this treatment or those who may in the future.

Before my last appointment with my psychiatrist my psychiatric pillbox looked like this:

Lamotrigine (Lamictal), 150mg twice daily

Aripiprazole (Abilify), 5mg nightly

Sertraline (Zoloft), 24mg daily

Alprazolam (Xanax), .5mg as needed for panic attacks

I also take gabapentin (Neurontin) at 400mg, three times daily, but for another disorder that I have. Still worth mentioning since it is a mood stabilizing agent. It’s also worth mentioning that as my manic symptoms worsened, my panic attacks have also worsened, therefore increasing my use of alprazolam.

When I first saw my psychiatrist for this specific episode, she initially increased the lamotrigine to the 300mg/day to see if that would help stabilize me. It didn’t, so she decided to go a whole new direction. My pillbox now looks like this:

Lamotrigine (Lamictal), 100mg twice daily

Brexpiprazole (Rexulti), .5mg daily

Alprazolam (Xanax), .5mg as needed for panic attacks

So the first week of my new regimen saw the sertraline and aripiprazole go completely. My lamotrigine was decreased and the Rexulti was added at a starting dose to be increased to a therapeutic dose in the coming weeks.

Rexulti is currently approved for the treatment of schizophrenia and as an add-on treatment for those with major depressive disorder who still experience symptoms after at least eight weeks of treatment with antidepressants. It is not yet approved to treat mania or as a maintenance therapy drug for bipolar disorder. Basically, I’m an experiment where n=1.

This first week has been more than a little challenging. I’ve still been dealing with manic symptoms. After all, this is a process. It’s medication, not magic. I’ve also been dealing with withdrawal symptoms from my other medications, which is in some ways worse than the symptoms themselves.

I’ve had difficulty concentrating and remembering. My head has been swimming so much that I just can’t think straight. I’ve been anxious and eating everything in sight. The problem is, I don’t know which of these symptoms are still just symptoms of mania, whether they are withdrawal symptoms or if they are side effects from the new medication. Only time will tell.